Objective: To assess long-term outcomes of reoperation for recurrent lumbar disc herniation, and to compare results of different methods.
Methods: There were 95 patients who had reoperation for recurrent lumbar disc herniation between February 1998 to February 2003, among whom a total of 89 (93.7%) were followed up and their primary data were reviewed. There were 76 patients, with the mean age of 42 years (range from 23 to 61), who met the inclusion criteria and were included. Among them, there were 55 males and 21 females. All patients had the history of more than one sciatic nerve pain. The mean recurrent time was 69 months (range from 8 to 130 months). There were 48 patients in L4,5 and 28 patients in L5, S1, of whom we chose 30 to undergo larger vertebral plate discectomy (or two-side fenestration) and nucleus pulpose discectomy (group A), 24 to undergo the whole vertebral discectomy (group B) and 22 to undergo the whole vertebral discectomy and 360 degrees intervertebral fusion (group C). The patients' clinical results in the three groups were compared, and the clinical curative effects were evaluated by using clinical functional assessment standard.
Results: Clinical outcomes were excellent or good in 80.3% of the patients, including 80.0% of group A, 79.2% of group B and 81.8% of group C. There was no significant difference in each group (P > 0.05). These three groups were not different in age, pain-free interval and follow-up duration (P > 0.05). The mean intraoperative blood losses in the three groups were (110.7 +/- 98.8), (278.7 +/- 256.3), (350.7 +/- 206.1) mL, respectively. The mean surgery time were (65.9 +/- 22.8), (111.6 +/- 24.3), (127.3 +/- 26.7) minutes, respectively, and the mean hospitalization time were (6.7 +/- 1.4), (10.2 +/- 1.8), (12.2 +/- 2.3) days, respectively. Group A was significantly less than group B or C (P < 0.05) and there was no significant difference between group B and C. All the patients were followed up for 36 to 96 months with an average of 86 months, and with(87.6 +/- 27.0), (84.5 +/- 19.8), (83.6 +/- 13.5) months of group A, B and C, respectively. At the end of the follow-up, there were more cases of spinal instability at the same level in group B (19 patients) than in group A (1 patient) or group C (no patient) in X-ray, and the difference was significant (P < 0.05).
Conclusion: Reoperation for recurrent lumbar disc herniation is effective. Larger vertebral plate discectomy or tow-side fenestration is recommended for managing recurrent lumbar disc herniation.